Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

443-SRH and MSK > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

what is osteoporosis

A

A skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

osteoporosis is a skeletal disorder characterized by _____________ predisposing to an increased risk of fracture

A

compromised bone strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

only ____% of fragility fractures are assessed for osteoporosis and only ____ of that will be treated

A

5-25%
half

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

bone strength is comprised of

A

bone quality + bone quantity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what makes up bone quality

A

microarchitecture, microfracture, turnover, mineralization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what makes up bone quantity

A

BMD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

why is peak bone mass important

A

major determinant of fracture later in life- determinants not well understood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what determines peak bone mass

A

Genetics is primary factor, nutritional status, physical activity, hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

in osteoporosis, less of _____ is greater than ____ bone

A

trabecular is greater than cortical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

which of the following is true
1. in menopause, there is low bone turnover
2. in the elderly, there is low bone turnover
3. early in osteoporosis, cortical bone is lost faster than trabecular bone
4. 1+2

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

fractures are multifactorial (3)

A

low BMD
impaired bone quality
falls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the trend of fractures from 50-60s and >70yrs old

A

50-60s = more wrist fractures
>70s = more hip fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the fracture cascade

A

fractures predict future fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

the impact of fractures
1. results in temporary physical sx
2. reduced mobility is seen in 100% of hip fractures
3. results in worsening of osteoporosis
4. associated with decreased survival after hip or vertebral fracture

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

list 3 RF for fractures

A

Age
Genetics: FHx (esp parental hip fracture)
Fragility fracture (falling from standing height) after 40yrs
Low BMI <20
Rheumatologic conditions; rheumatoid arthritis, systemic lupus
GI conditions: IBS, celiacs
Other: CKD, HIV, COPD, malignancy
Endocrine conditions: hypothyroidism, hyperparathyroidism, cushing’s syndrome, T1/2DM
Lifestyle: low calcium, vit D, current smoker (↑ osteoclasts), physical inactivity, too much alcohol (=>3 glasses/d), high caffeine
Hypogonadal states: early menopause (<45yrs), premature ovarian insufficiency, previous amenorrhea (ex- eating disorders), hypogonadism in men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

which of the following is not a RF for osteoporosis
1. low caffeine use
2. premature ovarian failure
3. diabetes
4. IBS
5. antiandrogen therapy

A

1- high caffeine use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

which 7 medications are strongly associated with osteoporosis

A

glucocorticoids
aromatase inhibitors
anticonvulsants
chemo
antiandrogen therapy
excess thryroid therapy
LT heparin therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

prevention of osteoporosis is required with using these 3 medications

A

glucocorticoids, aromatase inhibitors, antiandrogen therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is glucocorticoid induced osteoporosis

A

Use of systemic steroid for cumulative ≥3mths
MOA: ↑ bone resorption, ↓ bone formation, ↓ Ca absorption
At risk if ≥ 7.5mg prednisone daily for over 3mths (cumulative dose)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what decrease in height is significant in osteoporosis

A

historical >6cm (from peak height), prospective >2 cm (loss per year) is significant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are normal rib-pelvic and occiput to wall distances

A

<2cm
0cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

name 2 physical tests to do with osteoporosis patients

A

Rib- pelvis (>2cm) and occiput to wall (>0cm) distances
Timed up and go (TUG) test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

in the TUD test, a time of > ____ indicates higher risk of falls

A

> 12s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

vit D levels should me measured in those who (4)

A

Will be on pharmacologic tx for osteoporosis
Have sustained recurrent fractures
Have continued bone loss despite treatment
Have comorbid conditions that affect absorption or vit D action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

serum vit D should be measured after ______ mths of adequate supplementation

A

3-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

if optimal vit D levels are achieved
1. repeat levels qyr to monitor
2. repeat levels in 3-4mths fter continued supplementation
3. add calcium supplementtion
4. do no repeat levels

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

BMD is measured by

A

DEXA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

BMD is usually measured as

A

lumber spine, hip (femoral neck)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

bone mass =

A

bone mineral content / bone area (gm/cm2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

there is an ____ relationship between BMD and fractures

A

inverse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is the T score

A

number of SD a person’s BMD from the mean BMD in a young normal reference mean with beak bone mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is the Z score

A

number of SD a person’s BMD varies from the mean BMD (matched for age, gender, ethnicity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

a T score of +2.5 to -1.0 means

A

normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

a T score of -1.0 to -2.5 means

A

osteopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what are the T scores for osteoporosis

A

<-2.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what classifies as severe osteoporosis

A

< -2.5 with fragility fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

how to assess for vertebral fractures

A

spine Xray to look for compression fractures (ex- thoracic and lumbar spine X ray is commonly ordered)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

if a 50yr old and a 70yr old have the same BMD, who’s fracture risk is higher?

A

70yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

2 tools in canada used to assess 10yr risk of major osteoporotic fracture

A

CAROC
FRAAX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

which characteristics increase the CAROC risk to the next category

A

fragility fracture after 40yrs old, prolonged CS therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

which characteristics increase the CAROC risk automatically to high risk

A

hip/ vertebral fracture, >1 nonvertebral fragility fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

QUS is assessed at the

A

heel or wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

when is QUS used

A

useful in osteoporosis risk assessment, esp in areas with limited access to DEXA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

which of the following is not true
1. DEXA is the gold standard for measuring BMD
2. T and Z scores are ways to classify BMD compared to those in the same age group or in peak bone mass times
3. QUS may be used for treatment monitoring of BMD
4. QUS is especially useful in areas with limited access to DEXA

A

3- not for monitoring or dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

list the steps from bottom to top of the osteoporosis treatment pyramid

A

lifestyle
address secondary causes of disease
pharmacotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

lifestyle management of osteoporosis includes

A

exercise
calcium
vut D
smoking cessation, minimize caffeine and alcohol
fall prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

in terms of supplementing calcium in osteoporosis
1. recommended is 1200mg/d
2. preferred source is from supplements
3. carbonate and citrate have the same absorbability, but carbonate requires an acidic environment (food)3
4. recommended for people >60 or with osteoporosis
5. 1, 3
6. all of the above

A

5

48
Q

elemental calcium of _____ mg daily is recommended for people _____yrs or with _____

A

1200mg
>50yrs
with osteoporosis

49
Q

what is the preferred source of calcium

A

diet

50
Q

which is preferred if patient is on PPI or H2 blocker
1. calcium carbonate
2. calcium citrate

A

2

51
Q

T or F: calcium citrate should be taken with food or absorption is bad

A

F- calcium carbonate should be taken with food

52
Q

Doses _________ mg elemental calcium should be divided BID

A

> 500-600

53
Q

you have a low risk of vit D deficiency if you’re ____, no __________

A

<50yrs
no osteoporosis or conditions affecting vit D

54
Q

how much vit D should you take if you’re low risk

A

400-1000IU daily

55
Q

how much vit D should you take if you’re >50yrs or at mod risk of deficiency

A

800-1000IU daily

56
Q

those that are deficient may require ______ IU of vit D to reach >75nmol/L

A

2000IU

57
Q

Vit D2, AKA, _________ is from a ____ source

A

ergocalciferol
plant

58
Q

Vit D3, also known as __________, is from an _______ source

A

cholecalciferol
animal

59
Q

which is more potent? vit D2 or D3

A

D3

60
Q

~40IU of vit D3 increases vit D levels by

A

1nmol/L

61
Q

in lifestyle management of osteoporosis, caffeine should be limited to _________ and alcohol should be limited to __________

A

<4cups/d
<2 drinks/d

62
Q

hip protectors are recommended for

A

LTC residents who are mobile + at high risk of fracture

63
Q

repeat BMD must be
1. measured by a calibrated and standardized DEXA machine
2. must be measured by the same DEXA as before
3. must be done q2-3yrs on established osteoporosis treatment
4. must be done q3-5yrs for new tx

A

2

64
Q

FRAX recommends starting tx if (2)

A

Major osteoporotic fracture =>20%
Hip fracture =>3%

65
Q

what should be done if a FRAX comes back as <10%

A

do not tx, reassess in 5yrs

66
Q

what should be done if a FRAX comes back as 10-20%

A

consider tx based on additional RF and pt preference

67
Q

what should be done if a FRAX comes back as >20%, or prior fragility fracture, or multiple fractures

A

tx with pharmacologic tx

68
Q

what is usually used as primary outcome when testing osteoporsis drugs

A

vertebral fracture risk

69
Q

which 3 agents do not prevent all 3 of vertebral, nonvertebral, and hip fractures

A

etidronate and raloxifene vertebral only, teriparatide vertebral and nonvertebral only

70
Q

BP MOA

A

Binds to bone to inhibit osteoclasts (causes apoptosis)
Binds to areas with active bone remodeling- incorporated int bone with bone formation - released with bone remodeling to stop osteoclasts

71
Q

rank he binding affinities of BPs

A

zoledronic acid > alendronate >risedronate >etidronate

72
Q

which BPs are PO

A

alendronate, risedronate

73
Q

which BP may be taken with food

A

risedronate (actonel DR)

74
Q

PO BP SEs (list 3)

A

GI: abdominal pain/ distention, dyspepsia, diarrhea
MSK: muscle, bone, joint aches/ pain (usually after few mths of use)
Rare: esophagitis, ulcers with alendronate (unclear if risedronate same issues, but counsel the same)

75
Q

what is a rare SE of PO BPs? which BP is higher risk/

A

esophagitis, ulcers with alendronate (unclear with risedronate)

76
Q

how should you counsel a patient to take alendronate or risedronate

A

Take on empty stomach with full glass of water- best in morning 30min (1hr if weekly) before eating or drinking
Do not lie down for at least 30min after taking to improve stomach absorption (PO BPs bioavail <1%)

77
Q

how is zoledronic acid given

A

as a 15min infusion once a year

78
Q

zoledronic acid AEs

A

acute phase reaction- flu like sx 1-3 days after last injection (fever, chills, bone pain, etc)- can last 3-4 days in 10-20% of pts, renal impairment

79
Q

what can be used before ZA to prevent acute phase reaction

A

acetaminophen/ ibuprofen or diphenhydramine

80
Q

what should be monitored before injection ZA

A

calcium, phospate, SCr, GFR

81
Q

BP contraondications

A

Women of childbearing potential (not teratogenic, just incase)
Alendronate ? risedronate: abnormalities of esophagus, inability to sit/ stand upright for 30 min (if must use, use risedronate)

82
Q

if CrCL <35, avoid ________________ BPs

A

alendronate, zoledronic acid

83
Q

if CrCL <30, avoid this BP

A

risedronate

84
Q

what are 2 classes that interact with actonel DR

A

PPIs, H2RAs

85
Q

BP interactions (list 3)

A

calcium, iron, laxatives containing magnesium, antacids with magnesium, aluminum, or calcium, vitamins supplements containing minerals

86
Q

what is classified as BP induced ONJ

A

exposed bone in jaw that doesn’t heal after 8wks due to BP slowing bone turnover and healing

87
Q

BP induced ONJ is most common in ____ pts on ______

A

cancer pts on high dose IV BPs

88
Q

BP induced ONJ is associated with

A

major dental issues

89
Q

atypical femoral fractures typically occur along ___________ with ___________ trauma

A

distal femur with little or no trauma

90
Q

what is the potential mechanism for AFF

A

alteration of normal tissue repair process from continuous bone suppression

91
Q

AFF is associated with ____ BP use

A

LT (>5-7yrs)

92
Q

with atypical femoral fractures
1 .pts may report prodromal pain in arms, hands, and wrists months before fracture
2. rarely (<10%) bilateral
3. may be due to continuous bone suppression, then sudden increase after d/c
4. can occur with no trauma

A

4

93
Q

what class if denosumab

A

Human monoclonal antibody against RANKL

94
Q

denosumab AEs

A

MSK pain, rash/ eczema, infections, hypocalcemia, reports of ONJ and AFF

95
Q

there is an increased risk of _____ upon discontinuation of denosumab

A

vertebral fractures

96
Q

denosumab
1. requires avoidance if CrCL <30
2. requires avoidance if CrCL <35
3. does not require dosage adjustments with renal impairment
4. should monitor for hypercalcemia

A

3

97
Q

what is a SERM used in osteoporosis

A

raloxifene

98
Q

raloxifene MOA

A

agonist effect on ER on bone, lipids. Antagonist effect on ER on breast and uterus

99
Q

raloxifene (select all that apply)
1. decreases risk of breast cancer
2. is an agonist on bone, uterus
3. AEs include AFF, leg cramps, hypocalcemia
4. are contraindicated in pregnancy, past/ active VTE

A

1, 4

100
Q

raloxifene SEs

A

hot flashes, leg cramps, risk of VTE

101
Q

hormone therapy is currently an option for

A

women who have osteoporosis + mod-severe menopausal sx

102
Q

how much estradiol must be used to prevent fracture or prevent further bone loss

A

Reduce fracture: 1mg estradiol or eq
Prevent further bone loss; 0.5mg

103
Q

what ar ethe 2 anabolic agents used in osteoporosis

A

teriparatide
romosozumab

104
Q

after teriparatide is d/c, you must

A

Continue with antiresorptive agent after d/c for 2yrs

105
Q

teriparatide CIs

A

severe renal insuff, bone metastases, bone cancer, pts at risk of osteosarcoma (not shown in humans)

106
Q

romosozumab class

A

sclerostin inhibitor

107
Q

how is romosozumab injected

A

once a month SQ for 12mths

108
Q

how is teriparatide dosed?

A

SQ daily for 24mths

109
Q

romosozumab CIs

A

Hx of MI or stroke

110
Q

what are first line osteoporosis tx

A

alendronate, risedronate, zoledronic acid, denosumab

111
Q

anabolic agents in osteoporosis are usually reserved for

A

often reserved for pts with severe osteoporosis who have not responded to other tx (usually not covered + v expensive)

112
Q

when should you consider GIOP prophylaxis? what agents should be used?

A

if =>3mths of cumulative tx + 7.5mg prednisone qd (2.5-5mg if at risk already)
can use alendronate, risedronate, ZA, denosumab (+ teriparatide if not responding to other agents)

113
Q

how often should BMD be repeated in new tx? what about established tx?

A

New tx in 2-3yrs
Established tx in 3-5yrs

114
Q

which of the following is false
1. new osteoporosis tx should be monitored with a DEXA machine q2-3yrs
2. 50% adherence o osteoporosis medication has the same fracture risk as no tx
3. drug holidays may only be done with bisphosphonates
4. duration of drug holidays may be 2-4mths

A

4- 2-4yrs

115
Q

drug holiday duration ____, must start monitoring at _____

A

2-4yrs
monitor at 1-2ysr

443-SRH and MSK (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions